Provider Demographics
NPI:1336115369
Name:FLORETTA, MARIE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:FLORETTA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:LERITZ
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:6420 CLAYTON ROAD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1811
Mailing Address - Country:US
Mailing Address - Phone:314-768-8442
Mailing Address - Fax:314-768-8918
Practice Address - Street 1:6420 CLAYTON ROAD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-768-8442
Practice Address - Fax:314-768-8442
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO121731367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL493840807Medicaid
MOP00449515OtherRR MEDICARE
MO918649237Medicaid
MO918649237Medicaid